The Contribution of Surface Electromyographic Assessment for Defining the Stage of Peripheral Facial Paralysis: Flaccid or Sequelae Stage

Abstract Introduction Surface electromyographic activity may not be symmetric, even in subjects with no facial paralysis history. Objective To evaluate the contribution of the index of electromyographic (IEMG) activity in the identification of the two extremes of the facial paralysis course. Methods Thirty-four subjects with unilateral peripheral facial paralysis were selected. A control group was composed of volunteers without a history of facial paralysis. The electromyographic assessment of the facial muscle was performed by placing surface electrodes during movements of the forehead, eyes and lips using MIOTEC equipment, such as the MIOTOOL (Miotec, Porto Alegre, Brazil) software. The electromyographic activity was also recorded in other channels during the primary activity to identify the presence of synkinesis. The statistical analysis was performed using the Statistical Package for Social Sciences for Macintosh (SPSS Inc, Chicago, IL, USA). The IEMG activity was obtained from the division of the electromyographic activity root mean square (RMS) values on both sides. Results There was a statistically significant difference among the groups in all the analyzed indexes. The ocular-oral synkinesis in all patients must be correctly identified (with 100% sensitivity and specificity) using an IEMG activity of 1.62 as a cutoff point. The oral-ocular synkinesis must be correctly identified (93.3% sensitivity and 95.9% specificity) using the IEMG activity of 1.79 as a cutoff point. Conclusion The IEMG activity is below the normal scores in patients in the flaccid stage, whereas patients in the sequelae stage can either show normal values or values above or below the normal scores. The IEMG activity was shown to have high sensitivity and specificity in the identification of synkinesis.

Alteraciones de la motricidad del cuerpo del esófago en pacientes con enfermedad por reflujo gastroesfágico sin reflujo patológico en la monitorización de pH de 24 h / Esophageal motility disorders in subjects with esophageal reflux disease but without abnormal reflux, measured by 24h Esophageal pH monitoring

Background: In a high proportion of patients with symptomatic gastroesophageal reflux disease, 24 h esophageal pH monitoring is normal. Aim: To study esophageal motility in patients with symptomatic gastroesophageal reflux disease and normal 24 h esophageal pH monitoring. Patients and methods: Fourteen patients (12 women, aged 28 to 74 years old) with esophageal reflux disease and normal 24 pH monitoring and 14 asymptomatic controls (8 women, aged 19 to 69 years old), were studied. Symptoms were evaluated using an analog scale and all subjects underwent a barium meal, upper gastrointestinal endoscopy and a standard esophageal manometry. Results: Lower esophageal sphincter was normal in 11 patients, hypotonic in one and displaced to the thorax in two. Esophageal wave amplitude was lower in patients than in asymptomatic controls (10 to 50 and 13 to 70 mm Hg respectively). The proportion of hypotonic waves was Grade I and II in seven patients, Grade III in three and grade IV in four cases. Four patients had localized aperistalsis (that can be considered normal) and four had more severe forms of aperistalsis, along with severe hypotonia. Conclusions: Patients with gastroesophageal reflux disease without alterations in 24 h pH monitoring, have alterations in esophageal motility

Estudio de asociación entre magnitud de la hipotonía esfinteriana y transtorno motor del cuerpo esofágico / Association between lower esophageal sphincter resting pressure and esophageal motor disorders

Background: One of the most important factors involved in the pathophysiology of gastroesophageal reflux disease (GERD) is the lower esophageal sphincter rest pressure (LESRP), but these patients can have esophageal motor disorders (EMD). Aim: To assess an association between LESRP and the appearance of EMD in patients with GERD. Subjects and methods: A cross-sectional study was conducted in 229 patients with GERD and 49 healthy controls. Forty five patients with LESRP < 6 mmHg and a mean age of 49 years were assigned to group 1, 128 patients with a LESRP between 6 and 12 mmHg and mean age of 47 years were assigned to group 2, 56 patients with a a LESRP >12 mmHg and a mean age of 47 years were assigned to group 3 and group 4 was conformed by 49 healthy subjects aged 40 years old. Esophageal manometry was performed using previously published techniques. Results: There was a significant association between LESRP, waves amplitude and the frequency of tertiary waves. Conclusions: Resting lower esophageal sphincter pressure is inversely proportional to the presence of esophageal motor disorders in patients with gastroesophageal reflux disease

Alteraciones del tono muscular en una población infantil con riesgo al nacimento / Alterations in muscular tone of infants with risk at birth

Se estudió a un grupo de lactantes clasificados como de alto riesgo al nacimiento con el objeto de observar si tenían un mayor número de alteraciones del tono muscular en relación con lactantes que tenían mediano y bajo riesgo al nacimiento. Se observó que las alteraciones del tono muscular se presentaron en un 55 por ciento más en los lactante de alto riesgo. El hipertono de extremidades inferiores fue el que predominó en la población de alto riesgo (p < 0.01). La edad de aparición de las alteraciones del tono muscular se presentó en promedio para todos los lactantes a los 3 meses y desaparecieron al rededor de los 10 meses. La mayoría de las alteraciones del tono desaparecieron antes de los 18 meses, quedando en el grupo de alto riesgo 9/43 pacientes con alteraciones persistentes contra ninguno de los de mediano y bajo riesgo. Sin embargo 4 de éstos 9 pacientes se normalizaron a la edad de 19 meses. El desarrollo psicomotor se vio afectado con mayor frecuencia en los lactantes con alteraciones del tono y que fueron clasificados como de alto riesgo al nacimiento, (p < 0.05)

Unilateral ataxia following herpes zoster of spinal C4 segment.

Focal lesions of central nervous system are extremely rare following cutaneous herpes zoster. A 55 year old male developed cerebellar speech, right sided ataxia and intention tremor, three weeks after herpes zoster of right spinal C4 segment. Clinical examination and investigations confirmed a focal vascular lesion in the midbrain suggestive of granulomatous angiitis which can cause focal neurological defect after herpes zoster.